The head of New York City’s cash-starved municipal hospital system has sent an urgent letter accusing Gov. Cuomo’s administration of holding up $380 million in federal funds, leaving the system dangerously low on money.

“Today we have barely 18 days of cash on hand…” Stanley Brezenoff, interim CEO of NYC Health + Hospitals said in a Sept. 29 letter to state Health Commissioner Dr. Howard Zucker.

But Cuomo, in a statement released Friday night, shifted blame to President Trump and the GOP-led Congress, which is planing to slash federal aid to government-run hospitals that serve the needy — and Albany doesn’t have the funds to bail them out.

“I expect that these cuts will ripple throughout the health care system and effect virtually every hospital statewide. New York State has a $4 billion deficit and is not in a position to make up funding,” Cuomo said.

The governor said if the “missile hits” Albany will help “manage the cuts as best we can” but that Mayor de Blasio and other local governments need to step up to stabilized their municipal hospitals.

“New York City with a $4 billion surplus needs to help H+H,” he said. “The situation is clear, the first source of financial assistance for these hospitals must be their associated local governments . . . There is no passing the buck. But make no mistake, if our federal delegation fails in stopping these cuts, they will hurt.”

Cuomo’s office said barring action in D.C., the cuts go into effect October 1st and will cost New York Hospitals more than $1.1 Billion over the next 18 months.

In his letter, Brezenoff said Health+Hospitals is already delaying payments to vendors, “significantly” reducing hiring to replace attrition and taking other actions to preserve cash flow.

Brezenoff said that’s the big picture and “if I were to outline the view of the impact of these delays at the ground level– the point of service delivery — the examples would be even more alarming.”

In June, Brezenoff announced the firing nearly 400 managers to help close a $1.2 billion deficit in a nearly $8 billion budget.

Brezenoff said the nation’s largest public medical care system has already slashed its head count by 4,300 positions through attrition and other restructuring to stay afloat.

In a presentation to his board of directors Friday morning, Brezenoff said he was perplexed that the state had not given the municipal system the federal funds it expected to cover services to the uninsured — after Albany disbursed such funding to private hospitals.

“I can’t get my arms around the fact that other hospitals in the state, some of whom have bottom lines on the positive side of hundreds of millions of dollars are receiving this disproportionate share money and we are not,” Brezenoff said.

“It’s hard to imagine that $380 million will not be making a difference in what we can do, how we do it and when,” he said.